The healthcare needs of underserved communities are diverse and manifold. With HIV pandemic ravaging through India, and appalling healthcare systems, the need is compelling to integrate different tenets of healthcare services to make effective comprehensive HIV prevention, treatment, care and support a reality. Bobby Ramakant writes on such a model intervention which brings together different healthcare services under one ‘Multiplex Mobile Medical Unit’ moving through Gujarat villages in India.

Gujarat AIDS Prevention Unit (GAP) collaborated with The Brooklyn Hospital Center, USA and American Indian Association (AIA) to respond to these needs by coming up with a Multiplex Mobile Medical Unit, which is reasonably well-equipped bringing together medical, nursing, psychosocial counselling and pastoral care services for thousands of people from underserved communities in rural Gujarat (many of them living with HIV). The Brooklyn Hospital Center (USA) has sent a team of senior medical experts as well.

HIV gradually subdues the immune system of people living with the virus so that opportunistic infections (OIs) such as candidiasis, meningitis and tuberculosis can then exploit the body’s weakened defences. People living in poorer parts of India often have no access to clean water and sanitation, have bad nutrition and already weak health status, and are constantly challenged by a variety of infectious diseases. These factors place them at greater risk of HIV-associated OIs and are believed to significantly shorten the interval between initial HIV infection and the onset of AIDS-related conditions. As a result, HIV/AIDS is often called the ‘quintessential disease of poverty’.

Stigma associated with HIV prevailing in communities is enormous and has impeded the AIDS response of India considerably, said Dr Radium Bhattacharya, President of Indian Network of NGOs on HIV/AIDS (INN) and Chairperson of Gujarat AIDS Prevention Unit (GAP).

People with high-risk lifestyles or those living with HIV have to confront huge levels of stigma at every step – even within the healthcare settings. This makes it all the more difficult for them to have access to existing health services including HIV testing, detection of sexually transmitted infections (STI), STI treatment, regular screenings for opportunistic infections (OIs) and treatments (especially TB which continues to be the largest killer of people living with HIV despite of the fact that TB treatment is available free of cost and TB is curable!), nutritional counseling and food security, and not-to-forget other specialized medical care including antenatal care, paediatric care, and general medicine as well.

Quality counseling of people (with or without HIV) is very important. Most of the people with high risk behaviours in their lives have been craving for compassion and deprived of access to information and services as well. It is vital for counselors to establish a rapport with individuals before trying to redress their problems. Nothing is more therapeutic than compassionate shoulder, says Dr Radium.

Multiplex mobile medical unit is a response to the needs of the community in rural areas. The challenge was to provide high-quality medical care, which is free of cost (affordable), within the reach of people in their own communities (mobile clinics are accessible) and provide for an array of services from counseling, testing, medical care and provision of medicines as well. All the staff working in these mobile clinics demonstrated high sensitivity to issues around HIV, and people living with HIV have themselves taken leadership in putting up the camp as well.

India at least has more than 5 million people living with HIV. The incidence of HIV in rural India is rising. With gravely inadequate healthcare system to fall back upon, it is critically important to bolster our public education and health literacy programmes in rural India, said Dr Radium Bhattacharya, who also volunteers for AIDS CARE WATCH global campaign (http://www.aidscarewatch.org/).

With inadequate treatment programmes especially those of anti-retroviral (ARV) therapy, the number of people requiring 2nd line drugs is alarming. GAP is providing 2nd line ARV therapy to 5 patients who had developed resistance against 1st line ARV therapy earlier.

Jogender Upadhyay, a force behind community mobilization at GAP, said that Multiplex Mobile Medical Unit is a resultant of a survey on the needs of medical services carried out in the last 3 years in 20 villages of Prantij Taluka in Sabarkantha district (Gujarat). Total population of these three villages is around 60,000. These mobile medical units are providing family health counseling, reproductive and sexual health counseling, free condom demonstration and distribution, pre-test voluntary counseling, check up for opportunistic infections, sexually transmitted infections and reproductive tract infections and appropriate treatment, nutritional support, TB counseling, drug adherence counseling and treatment literacy, gender and foeticide awareness by multiple ways including poster exhibitions, street plays, games and inter-personal communication with the expert counselors.

There are some simple approaches to keep people with HIV alive. Many of them are already readily available, affordable and effective:

- Voluntary counselling and testing for HIV as the entry point for access to all health care services and self management- Prevention and treatment of tuberculosis (TB) in people living with HIV- Drugs to treat/prevent other opportunistic infections (e.g., cotrimoxazole, fluconazole etc)- Home- and community-based care approaches- Tackling HIV-related stigma, especially in health care settings, which often keeps people away from health services- Pharmacotherapy (e.g., methadone) for recovering injection drug users- Traditional healing and treatment approaches- Promoting food security and micronutrient provision.

People living with HIV often become entry points to communities in the provision of integrated AIDS-related services. This initiative is also effective in community education and delivery of a broad range of AIDS care services at the doorstep of the people in rural India. Community members are glad that quality healthcare services have been brought home for them.‘HIV is not a death sentence’ said a person living with HIV who came to this mobile medical unit. He firmly believes that AIDS-related conditions can be prevented and treated with established forms of care, support and treatment.

Such initiatives bring hope to people living with HIV. With 70% of Indian population in rural areas, the massive challenge is to make such interventions sustainable and replicable across the country.